DESCRIPTION (Applicant's Description): Methods of genetic screening for hereditary nonpolyposis colorectal cancer (HNPCC) are rapidly developing, and may soon move from the laboratory and genetics specialty centers to generalist physicians' offices and other outpatient sites. There is now a need to better understand the impact of genetic screening for HNPCC from an economic and patient-centered quality-of-life perspective. In response to the NCI's Career Development Award (Howard Temin Award), the candidate proposes to: (1) develop a flexible mathematical simulation model to estimate the cost-effectiveness of alternative genetic screening and postscreening surveillance strategies for HNPCC susceptibility; (2) estimate the impact of genetic screening for HNPCC on health-related quality of life of those who undergo testing. The research project anticipates the development of a colorectal cancer registry in response to National Cancer Institute RFA CA-96-011, "Cooperative Family Registry for Epidemiologic Studies of Colon Cancer." Patients from this registry will be recruited to participate in the health-related quality-of-life survey. As part of the career development plan, the candidate will take course work in genetics and genetic epidemiology from The School of Public Health and Community Medicine at the University of Washington. The c a ndidate's mentor, Nicole Urban, Sc.D., has extensive experience in mathematical modeling and conducting cost-effectiveness analysis of ovarian and breast cancer. The candidate's long-term goals are to (1) develop general research guidelines for applying cost-effectiveness analysis to genetic screening for commonly acquired malignancies; (2) utilize the results from cost-effectiveness analyses of genetic screening tests as part of the development of clinical practice guidelines for genetic screening that are directed at primary care physicians.